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Healthcare IT Is Drowning in Projects, Here’s Why | Newsday

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Drex DeFord: Hey everyone. I'm Drex Deford, one of the principles of this Week Health and the 2 29 project here. Our mission is healthcare transformation powered by community. This is Newsday on the UN hacked channel, breaking down the cyber and risk stories that are impacting healthcare. Here's some stuff you might want to know about.

Bill Russell: All right. It's Newsday and it's Drex, and I follow flying solo without Sarah today. We've got, we've got a lot to talk about. The, um, we, we just had a 2 29 summit over the weekend. Um, we can, uh, one takeaway from the seven, what have you got?

Drex DeFord | This Week Health: Oh man. Uh, one takeaway from the summit, there's still a lot of fundamental challenges around just there are too. There's too much demand and there's not enough resources and, um, we are chronically bad in healthcare at. Prioritizing. We're, we're, we're chronically bad in healthcare at [00:01:00] deprioritizing. Maybe that's a different way of saying it.

Bill Russell: You know what's interesting? You're in the CISO room. I'm in the CIO room, heard something. Fairly similar, which is we've got a, we've, we've, we've got too many projects still going on. It's like, uh, there's a disease that exists within the executive team. I don't think it's at the board. Do you think it's at the board level too?

Drex DeFord | This Week Health: I think it may be at the board level, but I, I think it, you know, some of this is, I don't know how, and depending on the health system, I don't know how much the board is read in on this. Like, there's 500 projects and, you know, there's really resources for 50 projects, so.

Bill Russell: how much of that do you think is, is on us? Within healthcare it that we haven't, uh, we haven't painted the picture. We, first of all, we don't measure resource allocation. We don't measure, uh, the time allocated and we don't paint the right picture to the organization. And we, we just allow them to continue to throw stuff on the pile without saying, whoa, like this, Hey, you see the line going out the door?

Like, we can't, we can't [00:02:00] finish this at this point.

Drex DeFord | This Week Health: think there's a, you know, some of this is just the, we still, we rely and our, our, uh, partners inside the health system, our, our customers. I hesitate to call 'em customers. The, our peers inside the health system, um, still leverage pretty heavily emotional arguments about why this thing should be done.

It's a patient safety issue. This is going to be, um, you know, this is gonna let us be able to do all these things. I think we're getting better over time at building business cases to do the things that we want to do in a health system. I think we're not great on the other side of the fence inside of information services. Of documenting how much capacity there actually is. There's a demand for a, I talk about this all the time. There's a demand to plant a lot of beautiful flowers in the garden, and we are not really good at talking about how much soil and how much water there really is for those flowers. And as a result, a lot of those flowers die in the process of being planted.

They just, they never, you know, we have failed projects. We have projects that didn't get the ROI that they anticipated, and [00:03:00] some of that's just because of. Capacity. We can't, can't get to them. And then the hobby shops start and the other things happen because we are not good at our jobs, which isn't really what's happening at all.

It's really just too much demand and not enough resources.

Bill Russell: This is one of the primary jobs of a CII, I wrote an article just last week on, you know, just say no. Um, I'm reminded who, who was that? That was, that was Nancy Reagan. Man, how old am I? I'm. Oh gosh. Um, Nancy Reagan's, uh, campaign for Drugs was just say, no. I think that's what it was. Was it drugs?

Drex DeFord | This Week Health: Yeah. No, I think you're right.

Bill Russell: Just say no.

I Don't know if we can bring it back, but,

Drex DeFord | This Week Health: And

I think it's all in the context of like, not just saying no to say no. It

literally is just the here is. We can fit this much work in. And it's not just, the other thing is information services teams aren't just doing projects. They're actually running all of the things that have been built over the hundreds of years.

Okay, not hundreds, but the dozen years, two dozen years, three dozen years since your health

Bill Russell: This, this is everything doing.

Drex DeFord | This Week Health: And then there's that [00:04:00] problem too, right? The change of like, the problems with change, the challenges with change and how hard it is for organizations to change. The other thing, I was talking to somebody about this morning, just a little while ago, who's coming to a summit that's in the future? often our executive partners. Their eyes are bigger than their belly, right? They think that the organization can absorb the change that's associated with all these projects that they're asking for, and that turns out to be a place where the cars, you know, the projects are crashing into each other too.

They're not successful, not because we haven't done everything and committed all the right resources. It's because the. on the other end, the, you know, the folks in the lab or RAD or pharmacy or nursing or docs or whatever not able to, man, there's too much change going on. I can't get with the program.

Bill Russell: Every organization in the CIO room was doing an application. Rationalization, project E, either an ongoing, and I think they've taken your advice. It's a [00:05:00] program now. It's not a, it's not a project.

Drex DeFord | This Week Health: ongoing thing.

Bill Russell: Right. Um, I did ask them if they have reduced the number of applications and the answer was, uh, not, not by as much as they had hoped.

Uh, and obviously that's the, that's getting back into that, that whole, um. Every, every new project coming down the pike. Um, but it, it is interesting to, to listen to them talk about application rationalization in the context of, uh, platform prioritization. And, but then also there's a, there's a recognition that they are seeding an awful lot of power to these platforms.

And there's, there, there's.

Drex DeFord | This Week Health: about that too.

Bill Russell: There's concern about it, but they feel like they're seeding it to the platform players that have earned the trust. Um, and, and we actually heard a couple stories of people pulling back from some platform players. That, uh, that have, uh, violated trust. I think violated trust is the right word, the right terminology.

They've, they've not played fair with, uh, with pricing. They've not continued to, uh, move their, their product [00:06:00] forward. Uh, there's, there's a significant amount of conversation around, uh, a different kind of partnership with these platform players where it's like you sit down with them and say, look, uh. I know you have a roadmap.

We need this on your roadmap,

Drex DeFord | This Week Health: Mm-hmm.

Bill Russell: and you could lose trust as a platform player if you are not keeping up with the demands of those organizations who are now, uh. They want to enter into that, that next level of relationship instead of, uh, leasing more buying instead of living together, more marrying, it's like, Hey, I, it's you and I, it's you and I, we're tight.

We're doing this together, but I need you to do some things. It, it's, it's almost that kind of conversation that's going on.

Drex DeFord | This Week Health: Did, did you hear? Did, did you hear? Did you hear, uh, folks in your summit talk about this idea that there are things that they have been buying apps, maybe niche apps or things that they want from those bigger partners that they can't seem to get to and they're thinking now about instead of. [00:07:00] buying those things, maybe they can just build them themselves, given the world that we're sliding into now with, you know, code and everything else.

Bill Russell: You know, it's a, well, so we, we shared one organization, right? So you had, you had the system, had the CIO, um, that came up. But on the CIO side, there's a heavy reluctance to allowing that to proliferate or encouraging that. And even the, even the CIO who said, this is a great thing, I love what the, the team has done is kind of leery.

It's like, man, are we gonna be able to support this? What's the long-term nature of it? Um, but even, but he said, you know, you, you can't, uh, you can't ignore the economics of it.

Drex DeFord | This Week Health: Does this go back to the resources question again? Like, I'm concerned that we're gonna build it and that we're not gonna be able to support it because we're not great. It's. all of the, it takes, you know, here's how much, mercury's in the thermometer and we're using this and this. Or maybe [00:08:00] it's the pie chart, whatever.

And like, here's how much discretionary spend you actually really have left. 'cause the rest of it's being used to.

Bill Russell: You know what this, this has been an age old problem for healthcare organizations. I remember when I came into St. Joe's and they're like, we're too busy. We can't do anything. And I was like. Okay, well I've gotta create margins somewhere along the line here so that they have time to do the things that we need to do.

'cause we need to transition. Almost everything they were doing is the arrogance of me. Almost everything they were doing was, was legacy and heading in the wrong direction. It's like, it, it takes us, you know, two and a half months to stand up a, a medical practice and I'm like.

Drex DeFord | This Week Health: How can

Bill Russell: Yeah, we, we've gotta change that.

Like we've got, we've gotta stand up 180 of 'em like that. What you're telling me is we can't do that for another five years. That's not gonna work.

Drex DeFord | This Week Health: But this is why, you know you're hired into these jobs, I think, you know, into these new jobs. The new version of the C-I-O-C-D-I-O kind of jobs is that you have to come [00:09:00] in with the reality that you're not just going to get a bigger pie. You have to put energy into, and sometimes that's like brute forcing the change that needs to happen to make sure that you can create margin that can be leveraged for. Innovation or new projects or whatever. And sometimes it's as simple as like renegotiating contracts to get additional dollars or reduce the number of fts that are doing app rationalization, because it means have my analysts spread as thin. It's all that kind of work, but it's actually a lot more than just that.

Bill Russell: I'll, I'll tell you what, Drex the, um, it, it's, it's the first of all, the, the user satisfaction, the economics of the project is not to be diminished. And by the time they listen to this news day, I will have published the article 'cause I got approval, um, from the person to publish it in the anonymous. It's impressive.

Well, he, [00:10:00] yeah, so he shared with me the the 20 page document. You could essentially take that 20 page document, drop it into an AI agent, it'll build it for you.

It's almost that now theirs is based on, you know, certain technologies, right? So they're using Clear, they're using Azure, they're whatever. And so if you don't have that platform, but a lot of health systems do, but if you didn't have that platform, you'd have to modify it. But if you had that platform, you could.

I mean, you could drop it in and say, build this. It'll build it. And you could be running what they're running, uh, you know, within, within, I don't know, within an hour or so.

Drex DeFord | This Week Health: Amazing. there some find and replace, uh, options for that prompt. Like you

Bill Russell: Uh,

Drex DeFord | This Week Health: just drop different technologies and, you know, this is instead of this, this, but you could still get the same, similar kind

Bill Russell: well, I, so this, this, uh. Friday, I think, or Thursday. This Thursday I'm doing training internally because I'm doing a ton of stuff with AI and I wanna make sure that the whole [00:11:00] team is benefiting from that. And one of the things that, that I developed, I didn't develop, I watched a video, copied a whole bunch of stuff, modified it a little bit.

And essentially created my own assistant with memory. And so in Claude Code it has memory. So it's keeping track of all the projects, all the things I'm working on. So I'd never have to remind it of something. 'cause the Claude MD file tells it, it's like, you know, Bill's working on, and I just say, update every now and then.

And it updates it, it says, Bill's working on these projects. So if you ask the questions about this, it's in the, all the files are in this directory and whatnot. So it has its own memory. Um, one of the things I'm working on right now is creating a. Uh, a prompt that I'm gonna give to my entire staff to say, okay, everybody let's, and we have an hour and a half set aside on Thursday.

You know, open up your Claude code. Not Claude. You know, they now. Claude, Claude co work Claude Code.

Drex DeFord | This Week Health: Okay. Mm-hmm.

Bill Russell: They also have routines now they also have design or whatever it's called. Um, they're, they're coding at a pace that's really unprecedented. [00:12:00] But, um, I'm gonna say, okay, and then I'm gonna say, here's the prompt.

Drop it in and you guys are gonna drop it in and it's gonna create it for you. And then you're essentially gonna have the assistant that I directs if I said it's saving me 40 hours a week, that probably is light.

Drex DeFord | This Week Health: Huh.

Bill Russell: I mean, not that, not that I was working 80 and now all of a sudden I'm working 40. 'cause we talked about, Devon's paradox on this whole thing.

But something that would've taken me like two weeks to sort of wrangle and whatever is now being condensed into, you know, hours like.

Drex DeFord | This Week Health: to this issue of, of generating capacity. I mean, there's so many things that we, I mean, folks can probably imagine with Bill and Sarah and I, there's no shortage of good ideas of things that we wanna do. Our problem is also, like everyone else's problem, we go, we have a lot of conversations about what we're gonna deprioritize uh, so create capacity to do these other things.

I mean, [00:13:00] even personally, right? Is. Is huge. If it can affect the team, it's gonna be even better.

Bill Russell: Um, I was kind of flippant. Well, part of my role in, in, we, we, we facilitate these meetings a little differently and Sarah facilitates search a little differently and I tell them upfront, you know. I, I wanna encourage them. They have the hardest job in the world. I want them to feel encouraged when they leave.

I said, but there will be times during this week where I poke you and I just go and, and somebody said, uh, said, uh, you know, Hey, we're using copilot. And I said, uh, how many people in here? That's, that's the AI you have access to? And it was almost all of 'em. 'cause they have the Microsoft license and that kinda stuff.

And I was like, you know, it it, it's almost like a. Like a, you know, there you go again. Like, I can't believe we're taking the most inferior AI foundation model. And I understand, I mean, they already have the license and all that other stuff, and this is, this is the tool we've given them. Um, and I'm like, man, the.

Uh, [00:14:00] right now Claude is outpacing these others, uh, including open ai. It is just outpacing them in order of magnitude because they have the genesis key. I don't know if you remember this, uh, uh, I think it was the Star Trek, the one of the star treks. There's the Genesis key, and essentially the genesis key for anything on, on technology is, is programming.

What, what, what philanthropic focused on almost a hundred percent of their energy was let's get coding. Right. And more than anybody else, they got coding. Right. Well, now that they have coding, right. They're just, they're, it's the genesis key. They're just like coding and, I mean, they're releasing so much stuff.

It's, it is un.

Drex DeFord | This Week Health: literally, I, this is a thing that kind of blows me away about all of them, but especially about that. Like every time I log on or every time I open up anthropic, there's a little thing that says, Hey, there's been an update. Can you, you know, click here to get the update, and you click here to get the update.

And the update turns out to be. Like, how are you [00:15:00] guys going this fast? There's whole new sets of features and capabilities that weren't there three days ago, and, and that's from the update three days before that. it is ama uh, I mean, the challenge of keeping up is also I think one of the themes that ran through all the summits of not just with ai, but with everything.

They're so, it's so hard to keep up with stuff.

Bill Russell: I was, I was looking for this design thing. 'cause it's a, it's a great example. Our, as a, as a team, we use script and we take these podcasts, give it to the team. It goes into script, which is a phenomenal tool, which is exceptional. And it was one of the first of its kind in that it would take this. It would do the, it would take this video, do the transcript, and then you could edit it like you did a Word document so you could say, oh, let's take that section out.

We just highlight, delete. And it would take the video out, it would take the audio out to edit. And, and since then they've just been innovating and staying ahead. Well, I watched the video over the weekend and [00:16:00] with Claude code now with this designer function, uh, that they, they rolled out, you can do videos.

And you could do videos and, and you could do like, take this and put it in the corner and put a, you know, a whiteboard up here on the left. And I, the minute you get ahold of this and really start, start using it, uh, I, I don't know how good it is 'cause I haven't played with it, but our team is going to land and, and the other, other, uh, team members are gonna play with it.

Once they do, I think your two minute drill is gonna be like, like CBS quality production.

Drex DeFord | This Week Health: everything.

Bill Russell: I think it's like, uh,

Drex DeFord | This Week Health: I mean,

Bill Russell: because,

Drex DeFord | This Week Health: there are, there's so many things that I always wanna show and you know, it's pretty much just a talking head, um, podcast today. But yeah, maybe that could be fun.

Bill Russell: well, because it's, it's, it's just like everything else you have, uh, it's the interface is, is your voice. The interface is, you know, what you type in there and more and more it's, it's, it, it's becoming your, your voice for these things. I, I noticed that, couple things and then we'll, we'll call it quits [00:17:00] here.

, Salesforce announced headless CRM and for those who aren't familiar with, uh, headless software, essentially what they're saying is, look, you're, you're gonna be able to get into this through a MCP server or some sort of backend, and anything you'd normally get through that front end of your CRM If log into salesforce.com and whatever, you're gonna be able to just go into your.

Your agent of choice, your, um, your foundation model of choice and say, Hey, pull up my clients. Uh, which ones do I have this? And this is the precursor for right now. We're still doing a lot of typing, but this is the precursor for, uh, the Star Trek era. Hey, computer, you know, what clients do I need to talk to this week?

Drex DeFord | This Week Health: I look at that too. And, um, I think that that continues to move us closer to this idea of, you'll have to use the user. from the vendor that you're using, but. long, you're going to, with things like Co Claude Code, [00:18:00] being able to kind of build your own front end with sort of the guide, the, the, the guardrails in the background. But you're gonna be able to get to whatever application you want, whatever multitude of applications that you want to build the front end that you actually find useful, and to be able to convert that completely into just a conversational. Just, you know, that kind of discussion, uh, kind of blows me away.

We're, we're so, it's going so fast. It's really unbelievable.

Bill Russell: Well, the last thing I wanna get to is, uh, security. So, uh, VL was hacked. Vls probably one of the largest, uh, JavaScript hosting companies around the world. Um, and, uh, so they got hacked. It's believed that, uh, well hackers are out there saying, Hey, we can sell you some credentials and that kinda stuff. And, um, the, uh, you know, is this just going to be.

A weekly or daily kind of thing for us that this got hacked. This got hacked. Change your API keys change your this. Um, I mean, is, is, is [00:19:00] this just the world we live in? Uh.

Drex DeFord | This Week Health: I think, I think it is kind of the world that we live in. I, and I think it sort of reinforces this idea of defense in depth. all of the stuff around Meha. And oh, well now we can find zero days and create a weaponization, you know, system for that zero day that we find. And we could do that in an afternoon.

And that used to take weeks. Right. I, I think we're in this mode of like, okay, well we can't just rely on patching. There's a whole bunch of other things that we need to do to make sure we defend our data, defend our networks, defend our end users, and ultimately defend our patients and families. I'm gonna talk about this more on two minute drill tomorrow, but you know this idea that It's a lot of patching if you do it. And now we're at that point where it's, I'm not saying stop patching, I'm just saying like, we never, we never did patching. Well, I mean there, there were always things that were left unpatched. We never got to, there were never enough resources to do all the patching and now everybody's kind of up in arms about, oh, well, there's [00:20:00] gonna be all these new vulnerabilities, and it's like, yep.

More reason to do all the other fundamentals and make sure that you're doing those really well. That's going to help more than anything else.

Bill Russell: Yeah, but your, your, your friend with the, uh, with the newborn, uh, I was talking to him about patching. Um, I like the approach they were taking. Um, I we're not gonna talk about it in detail here, but it, uh, it sounded near real time. The, the.

Drex DeFord | This Week Health: some auto patching for some things that are, that are going on. But there's still a lot of things. I mean, our concern in healthcare is we have a lot of legacy stuff we need to do testing. We need to take time and we have to be careful. 'cause if we break a system because we're patching it, we, you know, it's like we're hacking ourselves.

It's like, you know, self-inflicted wound. so we have to still be really careful and there's gonna be a lot of systems for a long time that are gonna be like that.

Bill Russell: Yeah, we had, we had a metric self, self-inflicted. Outage was one of our metrics and it was most [00:21:00] of our outages. It was well over 50%. It was, it was closer to 70 to 80% were self-inflicted outages.

Drex DeFord | This Week Health: Mm-hmm. Mm-hmm. Change control. Not having good documentation. Understanding what's talking to what, or what's relying on what in inside the, the network or between applications. All those are the things that are the booby traps. And if you can get those fundamentals right, you can really cut down on those numbers.

Bill Russell: That's really what it, I mean, if people take anything away from this episode, it's, the fundamentals are still so important. You have to, we had a great discussion around data and it's, it's like you, you have to get your data definitions right. You have to have your MDM, your stewards, your, you have to have all that stuff, right.

Because all the downstream stuff that or you're being asked to do has to be right. Same thing with patching, same thing with, you know, just the, across the board. It's like the, we, we have to master the basics every day.

Drex DeFord | This Week Health: Absolutely

Bill Russell: Drex always a pleasure. Obviously we miss Sarah, but, uh, you know, we'll, uh, we'll catch [00:22:00] up with her after she gets back from partying with, where's she at anyway?

Drex DeFord | This Week Health: don't, I don't, we, I, I have a hard time keeping track of her. She's

Bill Russell: Me too.

Drex DeFord | This Week Health: so many things going on and so many people to see and so many places to go that, uh, I feel like, I feel like we are on the road a lot, but she's really

Bill Russell: I,

Drex DeFord | This Week Health: doubled

Bill Russell: yes. Uh, whenever she tries to complain to me about being on the road, I just say to her, I'm like, self-inflicted. Whatever that is, it's self-inflicted. Like you, you cannot say no to these people asking you to, to be a part of their thing. So, uh, and we love her for it. She is so connected within the industry.

So, uh, well drex, that's all for now.

Drex DeFord: That's Newsday on UNH. Hack with Drex De Ford. Get daily security insights delivered to your inbox because every healthcare leader needs a community to lean on and learn from. Sign up at this week, health.com/subscribe and stay safe out there. I'll see you around campus.